"Transforming and Scaling up Health Professional Education and Training"

Global Policy Recommendations

Dr Erica Wheeler, Human Resources for Health,

Department for Health Systems, Policies and Workforce

2012 IAPAE 5th Annual Conference,

University of Witswatersrand,

Joh’burg, South Africa 1,6-18

September, 2012

Purpose of the Presentation

1. To describe the context in which the policy recommendations

are being developed.

2. To explain the objectives, scope and recommendations of the

guidelines.

3. To define what transforming and scaling up education entails

and describe the areas recommended for interventions.

Context: WHO response

2006

– Rapid scaling up of health workforce production (WHA59.23)

– Strengthening Nursing and Midwifery (WHA59.27)

2009 – Primary health care, including health system

strengthening (WHA62.12)

2010 – WHO Global Code of Practice on the

International Recruitment of Health Personnel

(WHA63.16)

2011

– Strengthening the health workforce (WHA64.6)

– Strengthening nursing and midwifery (WHA64.7)

Global Paradigm Shifts and Health Professional Policy

Changes

‘High Level Task Force on

Innovative Financing for Health

Systems’ published its report in

2009.

Work on Health Professionals in

the 21st century began in 2009

and report published in 2010.

United Nations (UN) High Level

meeting on Control and

Prevention of NCDs held in New

York (September 2011)

In 2009 the FDI World Dental

Association established the

Global Caries Initiative (GCI).

Context: A time for change

The 21st century has seen an increased focus on disease prevention and primary

care with a patient-centered approach at the core of health care delivery. However,

these changes need to be complemented and reflected in alterations in health

professional education and training.

The mismatch between the health needs of the population and education curricula

necessitates that 21st century reforms replace outdated curricula and teaching

methods with a socially accountable approach.

Education systems for health professionals require reform through needs-based

comprehensive curriculum design and innovative teaching methods, as part of a

competency-based approach.

Innovations along the education pipeline

Source: The World Health Report 2006 – Working together for health

Health Worker Education and Health

System Strengthening

Factors Driving Change

What we all have in common, is a desire to respond

effectively to changing population health needs.

A recognition that business as usual does not work and

will not address the shortage of health workers at the

country level.

We need strong health systems in order to deliver

effective, sustainable health care, particularly primary

health care.

So…

More health professionals, but not more of the same. We need to produce a new generation of health professionals. Globally competent, but locally relevant.

The process of reform requires a broad coalition of committed partners and a multi-sectoral approach between education, health systems and labor market to fit the realities of health service delivery.

A global social movement guided by strong technical instruments has to be nurtured to transform education to produce professionals fit for the 21st century.

Transforming and scaling up the education and training

of health professionals recommendations: what is it?

A series of policy recommendations and

guidelines that addresses the quantity,

quality and relevance of health

professionals and contributes to improving

population health outcomes.

"Quantity"

Quality "Quality"

"Relevance": health system

Primary

Secondary

Tertiary Most of the

population

accesses care

at the primary

level.

Pakistan 2007 data

Density of medical schools by region

(2008 estimate)

Actors in the reforms

The guidelines and policy options

Governance and planning

Regulatory frameworks

Education and training institutions

Financing and sustainability

Planning, implementation and evaluation

Recommendations: Transforming and Scaling Up Health

Professional Education and Training

All recommendations relate to improving the quantity, quality and relevance of health

workers

Political commitment and leadership is needed to transform and scale-up health

professional education. (Good Practice)

Formal collaboration and shared accountability between the Ministry of Health, the

Ministry of Education, and other related ministries (e.g. finance, labour, public

service), at national and/or sub-national level, in the education and training of

health professionals. (Good Practice)

Developing a national health professional education and training plan to produce

and retain graduates, which is developed in consultation with all stakeholders,

informed by the needs and absorptive capacity of the labour market, and aligned

with national human resources for health plans and national health plans. (Good

practice)

Recommendations: Transforming and Scaling Up Health

Professional Education and Training cont’d

Strengthening of the national human resources for health information system

(HRIS) to include multi-sectoral data elements that support the situation analysis,

monitoring and evaluation of the production, recruitment and retention of health

professionals. (Good Practice)

Creating or strengthening of national or sub-national institutions, capacities or

mechanisms to support the implementation of the reform and scale-up plan (e.g.

legislation, policies, procedures). (Good Practice)

Innovative expansion of faculty, through the recruitment of community based

clinicians and health workers as educators versus no such expansion.

The effectiveness of continuous development programmes for faculty and teaching

staff, including current health workers, which update and develop teaching skills

(e.g. curriculum development and instructional design), in both undergraduate and

postgraduate programs.

Recommendations: Transforming and Scaling Up Health

Professional Education and Training cont’d

Adaptation of curricula to needs through the definition of core competencies and

their incorporation into core curricula, in both undergraduate and postgraduate

programs.

Inter-professional (IPE) in both undergraduate and postgraduate programmes.

Simulation methods in the education of health professionals in high income

countries.

Direct entry of graduates from relevant undergraduate, postgraduate or other

educational programmes into professional studies.

Introduction/improving accreditation of health professional education.

Use of regulation to ensure the quality and relevance of health professional

practice.

Recommendations: Transforming and Scaling Up Health

Professional Education and Training cont’d

Streamlined educational pathways, or ladder programmes, for the advancement of

practicing health professionals, in both undergraduate and postgraduate

programmes.

Continuing professional development (CPD) and in-service training of health

professionals, which reflects reforms in education to address evolving population

health needs, and increase the coverage of services, with the engagement and

active participation of education and training institutions in its design and

execution.

Links to clinical rotations in remote and rural areas, CPD and specialization,

scholarships in return for practice. (Increasing access to health workers in remote

and rural areas through improved retention).

21 |

2013: Expansion of the guidelines

To date WHO has not covered cadres such as clinical

Associates, but this is changing. Given the paradigm shift

which is occurring among health professionals globally to

address population health needs, WHO is seeking to cover

other cadres of health workers through its normative and

standard setting mandate.

Discourse is already changing from MDGs to SDGs and this

has implications for health service delivery and the

attendant providers.

22 |

Next Steps

1. Better understanding of the cadres to be included and

existing practice.

2. Identifying networks, individual experts with whom to have

a dialogue to identify priority areas for global guidance.

3. Set up discussions to map out the way forward.

The End